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Medical Peace Work Online Course 7 Prevention of interpersonal and self- directed violence

Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

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Page 1: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Medical Peace Work Online Course 7

Prevention of interpersonal and self-directed violence

Page 2: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Course 7: Prevention of interpersonal and self-directed violence

General objectives:• Analyse the origin and extent of different

types of violence at the micro level.• Describe risk factors and prevention

strategies for each type.

Page 3: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Course 7: Prevention of interpersonal and self-directed violence

• Chapter 1: Preventing interpersonal violence

• Chapter 2: Preventing self-directed violence

Page 4: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Ch. 1: Preventing interpersonal violence

In this chapter you will learn:

• Outline the magnitude.• Describe the ecological

model for understanding and preventing violence.

• Describe the roles that health professionals can play.

Page 5: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

What is violence?

Definition by World Health Organization:

Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation.

(WHO, 2002:5)

Page 6: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Typology of interpersonal violence

(Source: WHO-Europe, adapted from WHO 2002:7)

Page 7: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Fatal interpersonal violence: Homicide

• 500.000 per year• 1.400 every day• Victims and perpetrators

mostly between 15-44 years

• Differences within regions: – Colombia: 146,5/100.000– Cuba: 12,6

• Differences within countries: (urban/rural, rich/poor, ethnic group)– USA: Homicide of youth (15-24 years)

• African-American: 38,6• Hispanic: 17,3• Caucasian: 3,1

(WHO 2002)

Page 8: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Deaths are only the tip of the iceberg

” For every death due to interpersonal violence there are perhaps hundreds more victims that survive.”

(WHO 2004:2)

Page 9: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Levels of non-fatal interpersonal violence

• Tens of millions of children – abused and neglected each year worldwide

• Up to 10% of males and 20% of females– report having been sexually abused as children

• For every case of homicide among young people– 20-40 non-fatal cases that require hospital care

• Rape and domestic violence– account for 5-16% of healthy years of life lost among

women of reproductive age

• 10-50% of women– experience physical violence at the hands of an intimate

partner during their lifetime (WHO 2002:9-11)

Page 10: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Estimates of non-fatal interpersonal violence

• Physically assaulted by an intimate partner:– Paraguay 10%– Philippines 10%– USA 22%– Canada 29%– Egypt 34%

• Ever been sexually assaulted (including attempts):– Toronto 15%– London 23%

• Involvement in physical fighting in the past year (adolescent males in secondary schools):

– Sweden 22% – USA 44%– Jerusalem/Israel 76%

(WHO 2002)

Page 11: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Indirect Costs

• Premature deaths• Lost productivity• Absenteeism• Economic development• Quality of life• Other intangible losses

• Premature deaths• Lost productivity• Absenteeism• Economic development• Quality of life• Other intangible losses

Direct Costs

• Medical• Mental health• Emergency response services• Law enforcement services• Judicial services

• Medical• Mental health• Emergency response services• Law enforcement services• Judicial services

Magnitude and impact

Source: WHO-Europe

Page 12: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Role of health professionals

Health Professionals

Victim services

Advocacy

Policy

Engaging other

sectorsResearch

Prevention

& control

Injury surveillance, evaluation

Injury surveillance, evaluation

Source: WHO-Europe

Page 13: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

A public health approach to violence

• From problem identification to effective response

Define the problem:

Data collection, surveillance

Identify causes:

Risk factor identification

Develop and test interventions:

Evaluation research

Implement interventions, measure effectiveness:

Community intervention, training, public awareness

(Adapted from: Mercy et al. 1993)

Page 14: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Timing of peace work

• Primary prevention– Risk factors – Protective factors

• Secondary prevention– Early warning– De-escalation– Conflict handling

• Tertiary prevention– Reconstruction– Resolution– Reconciliation

Page 15: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Ecological model for understanding and preventing interpersonal violence

Interpersonal violence as complex interplay of factors

(Dahlberg and Butchart 2005:99)

Page 16: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Shared risk factors for interpersonal violence

• Individual:Victim of child maltreatment, personality disorder, alcohol/substance abuse, history of violent behaviour

• Relationship:Poor parenting, marital discord, low socioeconomic household, violent friends

• Community:Poverty, high crime levels, high residential mobility, high unemployment, local illicit drug trade, weak institutional policies, inadequate victim care

• Societal:Rapid social change, economic inequality, gender inequality, policies that increase inequalities, poverty, weak economic safety nets, poor rule of law, high firearm availability, war/ post-war situation, cultural violence

Page 17: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Violence prevention interventions with some evidence of effectiveness

Key:• Well supported by

evidence (multiple randomized controlled trials with different populations)

◦ Emerging evidence

Type of violence:- CM: Child maltreatment- IPV: Intimate partner

violence- SV: Sexual violence- YV: Youth violence- EA: Elder Abuse- S: Suicide and other

forms of self-directed violence

(WHO 2009:2)

Page 18: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Global Campaign for Violence Prevention

www.euro.who.int/violenceinjurywww.who.int/violence_injury

www.who.int/gender

Page 19: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Course 7: Prevention of interpersonal and self-directed violence

• Chapter 1: Preventing interpersonal violence

• Chapter 2: Preventing self-directed violence

Page 20: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Ch. 2: Preventing self-directed violence

Learning objectives:

• Outline the extent of suicide around the world and variations in its incidence.

• Describe what makes people vulnerable to suicidal behaviour.

• Evaluate interventions to tackle suicide.

Page 21: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Defining important concepts

• SuicideDeliberately initiated act of killing oneself, performed in full knowledge or expectation of its fatal outcome (Wasserman and Wasserman 2009)

• Attempted suicide Action where the person intentionally hurts him- or herself, with a non-fatal outcome, and the intention was to die.

• Deliberate self-harmAct where the person intentionally causes self-injury, and the act has a non-fatal outcome. -Motivation: suicide attempt or no intention of killing oneself (Hawton et al.

2006)

Page 22: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Statistical picture

• Deliberate self-harm– More than twice as common among females as males– About 10 % of people (Madge et al. 2008)

• Suicide– About 1 million

each year– One each 40 sec.– Male > female– Atheist >

Buddhist > Christian > Muslim

(Bertolote and Fleischman 2002)

Page 23: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Vulnerability to suicidal behaviour

• Family structure and history• Economic factors• Health status• Life stress• Interaction of genetic and

environmental factors

Page 24: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Treating suicidal people and people who self-harm

• Problem-solving therapy • Intensive psychological therapy • Community outreach and increased

intensity of care • Pharmacological treatment

Other important resources:– Care and support of family, friends, social networks and

social care professionals– Health professionals can help to access these resources.

Page 25: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

Preventing suicide

1. Education and awareness programmes for the public and professionals

2. Screening programmes for those at high risk3. Treatment of psychiatric disorders4. Restrictions on access to lethal means5. Media reporting guidelines for suicide

(Mann et al. 2005)

• Primary prevention- population-wide interventions

• Secondary prevention- focus on high-risk groups

Page 26: Medical Peace Work Online Course 7 Prevention of interpersonal and self-directed violence

References

• Bertolote J, Fleischmann A (2002). A global perspective in the epidemiology of suicide. Suicidology 359:835-840.

• Dahlberg L, Butchart A (2005). Violence prevention efforts in developing and developed countries. International Journal of Injury Control and Safety Promotion 12(2):93-104.

• Hawton K, Rodham K (2006). By their own young hand. Deliberate self- harm and suicidal ideas in adolescents. Jessica Kingsley Publishers, London and Philadelphia.

• Madge N et al. (2008). Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. Journal of child psychology and psychiatry, 49:6, 667 677.

• Mann J et al. (2005). Suicide prevention strategies: a systematic review. Journal of the American Medical Association 294(16).

• Wasserman D, Wasserman C (2009). Oxford textbook of suicidology and suicide prevention. A global perspective. Oxford University Press.

• WHO (2002). World report on violence and health. Geneva, WHO. • WHO (2004). Preventing violence: a guide to implementing the recommendations

of the world report on violence and health.• WHO (2009). Violence prevention – the evidence. Geneva, WHO.

© medicalpeacework.org 2012Author Klaus Melf, editor Mike Rowson, graphic design Philipp Bornschlegl